Blood Tests for Diagnosing and Measuring Lupus

Blood tests are a critical part of detecting and measuring lupus. Even though currently available blood tests don’t offer certainty, new biomarker-based options may provide deeper insights.

When you get a blood test, a small sample of blood is taken from a vein or the finger and then analyzed. You may be asked to squeeze your hand or put a band or ribbon on your arm. This helps the clinician extract blood more easily. Otherwise, you also do not need to get ready for the blood tests listed below. There is no fasting or other preparations involved. Here is some information for if you are required to fast prior to the test.

Can you diagnose lupus with blood tests alone?

Today, you cannot diagnose lupus with a single blood test. Even antinuclear antibody tests are not definitive. They are just part of the puzzle. The current lupus diagnostic workup includes:

Behind the scenes: blood tests

After trained professionals take your blood, it is sent off to a lab for testing. The blood samples are kept track of throughout the process with barcodes. These barcodes don’t usually tell the lab technicians much about you, but they do make sure that you receive the correct test results when they are all done.

For many tests, the blood is first spun very fast in a machine called a centrifuge. The centrifuge forces the blood to separate into two different parts: the plasma (the liquid portion of the blood) and the serum (the solids that are in the blood). Blood tests can use plasma, serum, or whole blood, depending on the tests.

These days, tests are usually done by a machine which does the analysis under the supervision of a lab technician. The machine can do various things, including acting as a microscope or performing chemical experiments on the blood sample. Exactly what the machine is tasked to do depends on the specifics of the test.

Commonly used lupus blood tests

Complete Blood Count (CBC)

A complete blood count looks at whole, unseparated blood. The goal of this test is to look at the overall health of the various cells that make up blood, including platelets, white blood cells, and red blood cells. Of particular importance to lupus are the white blood cells, which are a part of the immune response. If white blood cell levels are high, that can mean that there are abnormally high levels of inflammation in the body.

While lupus is not always the cause, a complete blood count test can find signs of immune system distress, potential blood clotting issues, and anemia. These factors can have major impacts on the health of Lupus Warriors.

Clotting Test

Blood samples may be tested to see if they clot properly. If they aren’t, this can indicate that there is a problem with the platelets. This can be a sign of lupus, and can also be life-threatening if not investigated and treated.

Antinuclear Antibody Test (ANA)

The ANA test (AntiNuclear Antibody) looks for specific antibodies that are the usual culprits in autoimmune disease. Many of these antibodies attack the nucleus of cells, where the DNA is located.

Although a positive reading for ANA doesn’t mean that a person has lupus, ~97% of people with SLE have positive ANA tests. Still, a positive ANA is part of the clinician diagnosis checklist.

Other Autoantibody Tests

But, ANAs are not the only antibodies in the blood. Other antibodies can help clinicians understand problems because they are associated with particular conditions. For example:

Anti dsDNA is associated with systemic lupus erythematosus (SLE) and can be used to gauge severity in people with lupus nephritis

Anti-ro/SSA and Anti-La/SSB antibodies are associated with SLE and Sjogren’s syndrome

Anti-histone antibodies are associated with both drug-induced lupus and SLE

Because these antibodies are associated with other conditions, they are usually used to confirm a diagnosis, not make one.

C3 and C4 Reactive Protein Test

This blood test measures proteins called “complement” proteins in your blood. These proteins are masters at teamwork – they are called complement proteins because they assist each other in tracking down, marking, and killing disease-causing organisms like bacteria. Some act like triggers for others, causing a chain reaction that protect the body. This is known as an immune system cascade.

However, in autoimmune diseases such as lupus, the whole system is turned on its head and some of these complement proteins might be tracking down, marking, and killing a person’s own cells.

This is usually tested by causing a chemical chain reaction in the sample that mimics an immune response. The analyzing machine then measures how much of the complement proteins were consumed. There are many different complement proteins, labeled from C1 to C9, but the ones most commonly measured are C3 and C4. These are particularly low in people with lupus, so this test can be used to confirm lupus in at-risk people.

Erythrocyte Sedimentation Rate

This test measures the speed and amount of red blood cells (erythrocytes) that naturally settle to the bottom of the test tube without being centrifuged. If a lot of blood cells settle at the bottom over a short period of time, then it can hint at many body issues such as infections, cancer, and lupus.

New Technology: Biomarker Tests

Advances in predictive modeling and laboratory equipment are helping unlock new testing strategies. Researchers and companies are working on improving the accuracy of blood tests with the help of biomarkers. For example, Progentec is developing 3 new lupus blood biomarker tests:

a flare prediction tool

lupus disease activity level

a lupus diagnosis tool

These new tests provide Lupus Warriors and their treatment teams with actionable insights into lupus. Are treatments working? Is it really lupus? Progentec is working to help provide answers to those questions and more which can radically improve the management of lupus.

[Editor’s note: Progentec owns LupusCorner]

Should I get blood tests?

In general, yes. Get blood tests done for lupus as recommended by your doctor.

If you are worried about side effects, only a few test tubes of blood are taken so it is rarely harmful. You may feel pain or soreness at the site. But, other side effects such as swelling, bleeding, fainting, and infection are very rare.

There are many methods to help distract you from the needle stick if that bothers you. There are even special devices that use cold and vibration to cancel out the pain of the needle. Though you should always make sure that you can handle the vibration and temperature change before using it.

Blood tests are low-risk and don’t take much time. They can help confirm a diagnosis and help you better understand your unique lupus symptoms. In the end, this enables you to create a treatment plan that is right for you.

Do I ask my rheumatologist or hematologist for the new Progentec blood test? I have not had a complete blood work with C3/C4 in almost 2 yrs. CBC yes, and IGG cuz I am currently get infusions for low IGG 3 and 4.

I had all the tests my md wanted me to have. Only the ANA was off. Why don’t they look at the whole patient, their symptoms, and actually take time to look, and talk about symptomolgy with the patient. I was told it would be 8 months to see a Rheumatologist. Also, I was told to move to a dryer climate like Arizona. What is wrong with our MD’s? Any suggestions will be great!!

I have waited months to see specialists as well and after only 10 minutes of trying to descibe my symptom history they cut me off and want to run bloodwork that, until recently, all came back normal. This, they concluded nothing was wrong in spite of my 50 different symptoms involve every system of my body. It is totally ridiculous! After 20+ years of being sick and finding no answers, my bloodwork is FINALLY displaying abnormalities and the doctors are FINALLY paying attention and trying to help me. But I had to get to the point were I’m half-dead for this to happen.

I was in the hospital with pericarditis and all the markers showed up in my bloodwork, but had to wait 6 months for an appointment with rheumatologist. The bloodwork done at rheumatologist only showed positive ANA, high ACE and moderate positive RNA Polymerase. Waiting to see what rheumatologist says about test results. Appointment is not until October.

I’m sorry for the tough time your going through. I was first misdiagnosed with MS. Ms and lupus can look alike especially if lupus is attacking your central immune system. My point is there is a criteria of 11 that a patient has to demonstrate before receiving a diagnosis of lupus. I also found out through credible research that primary doctors are not always well informed of lupus. I would keep a log of your symptoms. My rheumatologist has me take pictures of rashes or swollen joints. Sometimes we are at our sickest when we don’t have a app and when we do we recover. It’s a frustrating disease. I wish you the best of luck at your future app.

Hi Deanna,
These tests are primarily used to provide a more accurate picture into the current level of disease activity with lupus. By doing so, they will help your clinicians better measure the success of treatments and develop better plans.
Thank you for writing in and being part of the LupusCorner community — If there are other topics that would be helpful for us to cover, please let me know
-Brett

Constant battle to fight! Last lupus flare for me was attacking the heart. Finally got fluid under control yet now fighting kidney and liver from the meds given for heart! I just continue to go daily with faith in our great God!

My mother had lupus, diagnosed finally after years of suffering. My brother has lupus and it’s really taking a toll on his body. I have some of the same symptoms but was told by 2 doctors that there is no definitive answers at this point. How likely is it that I could have lupus also?

I have a permanent blood clot. When I found out I had this I tested positive for the Lupus Anticoagulant. I know this does not mean Lupus. Twelve weeks later I tested Negative. I felt better at the time. I have Discoid lesions on my scalp and had Anemia. My arms are numbing now. I feel awful, I feel better. My white cells have spiked and I was hospitalized.
Tongue sores and other markers. My sister passed from Scleroderma at 44. Mom had Rheumatoid. Daughter has Graves. I had ITP and a splenectomy in my 20s. I’m 68 now. Four months to see a Rheumatologist. I spend my life quite confused.

I started having issues when I was in my early teens. These were listed as growing pains or my wanting attention. During my late teens, I spent months in the hospital, yet no type of diagnose was made (spend more that 2 days in a hospital now days and you will be labeled with all types of things). As the years moved, I spent more and more time in doctors’ offices & hospitals. More things were noted, but testing was limited. From what I gatherer, if the ANA is negative, additional test are not performed. A couple of years back, I went to a new Rhem. Due do my past (and prompt from my PCP), the whole range of testing was performed.
OMG, I am well into my 60’s and they have discovered I have positive ENA readings. I say discovered because the docs act like i’ve not suggested this for some 50 years.
They want be to take a cabinet full of medications, and are surprise that i refused.
Over the years, I have come up with ways to deal with my pains, rashes, tiredness, and other issues.
To the doctor who said i was faking, in a effort to collect disability – “I’m of age now!”